The ankle joint is made up of 3 bones: the tibia, fibula, and talus. The ends of these bones are covered with cartilage and are connected by strong ligaments to form the ankle joint. Cartilage is the smooth surface that allows the joints in our body to glide and function. The ligaments surrounding the ankle joint assures proper alignment and proper function. When either of these components are damaged or worn out, this can lead to arthritis.
The most common cause of ankle joint arthritis is post-traumatic arthritis due to a prior injury such as an ankle fracture or ankle sprain, 2nd most common cause is primary osteoarthritis or wear and tear arthritis. Other less common causes include gout, rheumatoid arthritis, neuropathy, osteonecrosis, hemophiliac.
Symptoms of ankle joint arthritis include pain with weight bearing and decreased motion. Exam findings include joint effusion or swelling, pain with motion or loss of motion, crepitus or grinding with motion, and deformity. X-rays will show signs of arthritis including loss of joint space, sclerosis or increased density of the bone underlying the cartilage, cysts or pockets of bone loss to the bone under the cartilage, as well as angular deformity.
Treatment includes conservative as well as surgical options. Conservative options include activity modification, bracing to immobilize the ankle joint, injections, and NSAIDs for pain control. If conservative treatment fails then surgical options are explored. Surgical treatment options vary based on severity and symptoms. For less severe cases, an ankle arthroscopy may be performed to clean up the joint and remove any spurring surrounding the joint that may be causing pain. This may also be performed along with a new procedure called a subchondroplasty which is a minimally invasive procedure that has shown effectiveness in treating pain and preventing or delaying the need for more invasive surgical options. For more severe cases an ankle joint fusion or ankle joint replacement may be an option.
Ankle joint fusion involves removing the remaining cartilage within the ankle joint and placing screws and/or plates to fuse the joint. Fusing the ankle joint prevents any further motion and thereby any pain associated with arthritis. Despite the inability to move the ankle, many patients lead healthy and functional lives without the pain of ankle joint arthritis.
Ankle joint replacement involves a procedure similar to a knee or hip replacement. This involves replacing the joint with a metal implant and polymer spacer. The advantages of ankle joint replacement is the maintenance of joint motion and function. The disadvantages are that ankle joint replacements are a relatively new procedure. Recent 5-10 year studies of newer generation ankle joint implants have shown good to excellent results, but long term outcomes are still pending. As with any artificial joint, there is increased risk of failure and revision with patients that are younger, higher BMI, and higher activity level. These are compounded by the increased forces within the ankle joint and decreased surrounding muscle and soft tissue compared to the knee or hip.
Your foot and ankle specialist at Advanced Foot and Ankle Center in Mckinney and Prosper TX will perform a thorough examination along with x-rays and other imaging and recommend the best course of treatment. Call us today at 972-542-2155 to set up your appointment!
Look out for our next blog post about Peroneal Tendon injuries, and other related conditions.